HomeMy WebLinkAboutPermit Building 1981-6-17
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INSPECTION LINE
7260-3769
CITY Of SPRINGfiElD .
COMBINATION APPLICATION/PERMIT
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INFORMATION LINE
72'-'375:1
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Add,e"
phone
ENERGY SOURCES:' ~l Sq. fig. Main
Heat Sq. Fig. Accen.'
Water Heal.r .. Sq. rig. Other
Ran_ge ..,,:....New_Add_Ah.r-:...R~p. ~;: ~ .
I Yolue of Work: __F.~c.~Demo_Chang.'/Ui..'~ 0
I 72,488:60\',._01." \, "r\"\-
. Building Permit Info: Describe Work (i.... Build Single \...J'-I iVV,. J
Family Residence-With Attached GoraQe\ ---.::> L
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Job Add,... 5809 ~Iain Street
I....' o..u;.". 17-02-33-44. Tax Lor. # 100
Owner
~UL Propert i es
Construction Lend.r
Complete Dr. Offices
Address
Phone
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SEE JOB # 810168 FOR SHELL INFORMATION
DESIGN TEAM
(nome)
(address)
".. (lin: no.)
(expire,)
(phone no.)
Electrical
,W61.T WAlml'1l
.DAVE ROGERS
KU\,;Jel\.:) r:;!'(l,.J.11~Cr:.t\.11\jU Ul\Vur
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Primary
6RT DA7
ART PAZ
!)tructurol
Mechanical
CONTRACTORS
(name)
(add,,,n)
(lies. no.)
(expires)
(phone no.~
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Plumbing
MJL PROPERTIES (~~RSHAL SMITH)
V AND M PLUMBING
ERMEL PHILLIP
RON PIERCE
General.
Electrical
Mechanical
PLUMBING
, ElECTRICAl
MECHANICAL
J
FEE ~CHAR~E. ~
NO. .
FEE ~ CHARGE
NO. l
I FEE
I CHARGE
NO. l
Duplex (1 bath) each
Temporary :Co~'~'tr~ction
7
furnace/burne, to
IlTU',
Appliance vent
separate
Stationary evop.
cooler
Vent fan with
single duct
Vent system aport from
heating or A.C.
Mechanical exhaust
hood and duct
3.00 21. 00
-r
:1
Residence of
32 Each singl. fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 both)
5.00 160.0r
",.ft.
New circuits, alterations
or extensions
SERVICES
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"-">-
Additional bath
Amps.
Wat.r service
Sewer
Wood stoy.theater ,,:.!
,',
. .
Starm Sewer
FEEDERS
Heat Puma
Air handler to
10.000 CFM
Air hondler over
10.000 CFM
Amos.
1
COMPRESSOR
6.00
-
"
10.00 '
37.00
ISSUANCE OF PERM.IT
TOTAL CHARGES
160.00 TOTAl CHARGES
TOT Al CHARGES
, I WHERE STATE LAW REQUIRES .hat the Electrical work be done by the E1edrical Contrador, the electrical portio", of this permit shall not be yalid until a
label has bMn signed by an Electrical Contrador and attached to the electrical pontI!.
I HA VE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true and' correct, and I further
certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield ond the laws of the State of Oregon
pertaining to the work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I further
certlfy that my registration with the Builde"s Board is in full force and effect os required by ORS 701.055, .hat if exempt the basis for exemption is noted
heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
NAME (please print)
414RsIIAU
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SIGNATURE It)/luid--:~
FOR OFFICE USE ONLY
DATEIo-/7-{JL
Basil for Builder's Boord exemption:
Zone
KA
1rype/Const.
"edrooms
VN
Unih
t"iccy Load
-"'ccy Group
R?
C"j. Ftg. Main ....:......-.A."9.:1
<". Ftg. A,,,,.. SHELL VALUE
Sq. Ftg. 0..., RA I.ANrl'
x .:11 - QO_Value
x Value
x .'alue
TOTAL VALUATION
firo Zone
Flood Plain
1I;:""i-..
PLUMBING PERMIT
Charges and
Surcharges
233.00
--------
9.32
160.00
6.40
Plan Ck. Comm/lnd
65%/ Blda Per Fee
Plan Ck. Res
30%1 Bldp Per Foe
151. 45
Systems Development
(htm.,. fl.5%l
1',087.33
BUilDING PERMIT
Chargo. and
Surcharges
--1:::. X
45.50 DUE
Fence
PLAN CHECK DUE
45.50
Demo
Total Comb. Permit
ELECTRICAL PERMIT
Charges and
Surcharges
Sidewalk
Alc PaviRll
MECHANICAL PERMIT
Charges ond
Surcharges
37.00
.-------
1.48".
Curb Cut
TOTAL
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1,580.03
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT V ALIDA TlON
I. Applicant to furnish
,A. Jab Address
,B. Legal Description
1. example-tax lot 100, Lane County Map Reference 17 03 43
2. example-Lot 1. Black 3, 2nd Addition to Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceiling/or forced air ~as
2. example.water heater/electrical/or solar
E. Square footage or valuation, etc. . .
1. example-1250 sq. foot house, 500 sq. foot garage (
2. example-if new project, check new-if addition, chec
add, etc.
F. Building permit information:
1. example.construct single family house with an atta td
garage
2. example-remodel existing garage into family room
3. example-convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Divisi
Staff must be able to contact appropriate persons rege
design information or job site corrections, etc. C'
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CITY OF
SPRINGFIELD
~
City Hall
Springfield, Orogon
Department of Public Works
OFFICIAL RECEIPT
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(,No. B 5 6 7 4 7 (f
Dote () - /1 19 51 I
( Rec'd FromSr-ttd . s:- n_/.'IJ-, ~f1J\~~<f
A~ P. D. &'i /(f):? I ~ F) ,(t.. .
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II. Abbreviated Plumbing, Mechanical & Electrical Schedules
A. Except where blank spaces occur in the description po
of the Mechanical and Electrical Schedules, the applic. (
need fill-in only the No. Boxes adjacent to the approp
item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedule
have been abbreviated
2. If the item(s) to be installed are not covered on the
aled schedules you should consult the full schedule
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES Ar
CHARGES ON THE SCHEDULES
Received For:
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III. Applicant to sign and date
Whenever possible, the initial application will be used as (
worksheet only. Where possible, Building Division Staff v
prepare a typewritten copy and return it to the applicant
the time the actual permit is issued for his signature.
IV. Fees and Charges
Plan check fees are due and payable at the time of the a
and no plans will be processed until these fees are paid.
other fees and charges are due and payable when the pi (it
is issued. .J- ~f
V. FOR OFFICE USE ONLY
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Amount Received
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AUTHOlll12ED .,GNATUIIlI[
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'1 Permit Cler~
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
PLANS REVIEWED BY:
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